From the Guidelines
For a 77-year-old female with unintentional weight loss and nausea, a comprehensive diagnostic workup including a complete blood count, chemistry profile, abdominal CT with contrast, and endoscopy of the entire upper gastrointestinal tract is recommended. This approach is based on the latest guidelines for evaluating symptoms that may indicate gastric cancer, such as weight loss and nausea 1. The initial workup should enable classification of patients into different groups, including localized, locoregional, or metastatic cancer, which is crucial for determining the appropriate treatment plan.
Key components of the diagnostic workup include:
- Complete blood count (CBC) to evaluate for anemia
- Chemistry profile to assess liver and kidney function
- Abdominal CT with contrast to evaluate for intra-abdominal abnormalities
- Endoscopy of the entire upper gastrointestinal tract to evaluate for gastric or esophageal pathology
- Chest imaging to rule out pulmonary malignancy
- Pelvic CT scan or ultrasound for women to evaluate for gynecologic abnormalities
Given the patient's age and symptoms, it is essential to consider the possibility of malignancy, gastrointestinal disorders, or other serious underlying conditions. Early diagnosis is critical, as unintentional weight loss in the elderly is associated with increased morbidity and mortality. The use of PET-CT scans may be optional, but they can be useful in evaluating recurrent gastric cancer or predicting response to preoperative chemotherapy 1. However, histologic confirmation of occult PET-avid metastasis is recommended to avoid false-positive results.
From the Research
Recommended Testing
For a 77-year-old female with unintentional weight loss and nausea, the following tests are recommended:
- Complete blood count 2, 3, 4
- Basic metabolic panel 2, 3
- Liver function tests 2
- Thyroid function tests 2, 3, 4
- C-reactive protein levels 2
- Erythrocyte sedimentation rate 2
- Glucose measurement 2
- Lactate dehydrogenase measurement 2
- Urinalysis 2, 3
- Fecal occult blood testing 2, 3, 5
- Chest radiography 2
- Abdominal ultrasonography 2
- Computed tomography angiography (CTA) of the abdomen/pelvis may be considered if chronic mesenteric ischemia is suspected 6
Considerations
- Medication use and polypharmacy can interfere with taste or cause nausea and should not be overlooked 2, 3
- Social factors may contribute to unintentional weight loss 2
- A readily identifiable cause is not found in 16% to 28% of cases 2
- Upper gastrointestinal studies have a reasonably high yield in selected patients 3
- Nutritional supplements and flavor enhancers, and dietary modification that takes into account patient preferences and chewing or swallowing disabilities may be considered 2